Superficial Temporal Artery- Middle Cerebral Artery Bypass Long-term Follow-up Study

Background:1967, Yasargil first reported the use of the superficial temporal artery-middle cerebral artery anastomosis in the treatment of ischemic cerebrovascular disease, intracranial and extracranial vascular anastomosis represented surgery were all the rage. But in 1985, magazine "New England Journal of Medicine" published a prospective, randomized, controlled clinical trials concluded: intracranial and extracranial vascular anastomosis does not reduce the incidence of ischemic stroke probability, therefore, intracranial and extracranial vascular anastomosis surgery drastically reduced the number of cases, but there are still some scholars has not given up on such surgical exploration. In the 21 st century, clinical trials for the 1985 re-evaluation of the conclusions of the voice rising, many scholars and theoretical application of new technology to verify intracranial and extracranial vessels anastomosis can improve the incidence of ischemic stroke.Objective:By summing up the line superficial temporal artery- middle cerebral artery anastomosis of preoperative and postoperative and long-term follow-up of 3-4 years of data, statistical differences between the various groups compare and analyze the factors affecting the efficacy and survival prognosis, etc. issues, in order to seek better treatment options, symptomatic internal carotid or middle cerebral artery occlusion efficacy and safety.Method:A retrospective analysis of our department since between February 2011 to November 2011 31 routine superficial temporal artery- middle cerebral artery anastomosis in patients with clinical data, records and statistics into the group of patients with baseline data before and after surgery and follow-up of imaging findings, perioperative adverse events, the long-term clinical follow-up process, the occurrence of ischemic events, after the establishment of a database for statistical analysis using SPSS software. By results of this study and similar studies done abroad compared to prove their effectiveness and safety.Results:31 cases were successfully superficial temporal artery- middle cerebral artery anastomosis, after 7 days, cerebral angiography, patency rate of 100%. 3-4 year follow-up after two cases of ischemic events and one case of hemorrhagicevents, which operated side associated with recurrent ischemic stroke in one case(3.22%), one case of hemorrhagic stroke(3.22 %), stroke incidence was 6.45%. During follow-up there are 15 cases(48.39%) of patients in the vascular anastomosis line CTA examination, a total of one case(3.23%) anastomotic stricture, No deaths, morbidity was 3.23%. All patients were in follow-up. By separately before surgery, on the 7th, 3-4 years compared m RS score, p = 0.023, p = 0.01. Preoperative and postoperative 7th, NIHSS score of 3-4 years for comparison, p = 0.023, p = 0.01, above all p<0.05, suggesting that vascular anastomosis is effective. For three kinds of arterial occlusion classification test, the difference between the 4 p = 0.011(p<0.05): For three kinds of cerebral typing test, the difference between all p> 0.05: The overall effect for cerebral vascular anastomosis between the three kinds of typing the same. Using KM analysis showed: With time, the incidence of stroke events also reduced. By Cox Risk Analysis: internal carotid artery occlusion type row after surgery prognosis is better than the middle cerebral artery occlusion or severe stenosis of the type of case law after oral aspirin prognosis than patients disabled, but no prognosis for cerebral type statistics significance.Conclusions:1. superficial temporal artery- middle cerebral artery anastomosis is an effective and safe surgical approach.2. The current superficial temporal artery-middle cerebral artery anastomosis only for some of the main artery from severe stenosis or occlusion caused by hypoperfusion, slow flow and other hemodynamic disorder patients with ischemic stroke.3. The internal carotid artery occlusion is superficial temporal artery- the best indications for cerebral artery anastomosis.4.The superficial temporal artery- middle cerebral artery anastomosis must be developed individualized surgical approach depending on the patient, the former technique carefully detailed judgment on the prognosis of patients have enormous help.